The second thoracic sympathetic ganglion determines palm skin temperature in patients with essential palmar hyperhidrosis.
Sympathectomy of the second (T2) and third (T3) thoracic ganglion is frequently performed for essential palmar hyperhidrosis and occasionally performed, in addition to stellectomy, for idiopathic Raynaud's disease. The increased palm skin temperature after the operation probably results from increased skin perfusion. To determine whether it was possible to limit the extent of sympathectomy for these patients, we recorded palm skin temperature after electric stimulation of stellate, T2 and T3 ganglia, and after randomized electrocautery of T2 and T3 ganglia in 20 patients. We analyzed the statistics according to paired t-test with Bonferroni adjustment. We found that palm skin temperature decreases significantly after stellate stimulation. While rising significantly after destruction of T2 ganglion in the presence of intact T3 ganglion (P = 0.00001), palm skin temperature did not rise significantly after T3 destruction in the presence of intact T2 (P = 0.779). Following T2 and T3 destruction, however, palm skin temperature rose despite stellate stimulation. This suggests that T2 ganglion determines palm skin temperature while stellate and other upper thoracic ganglia may play a minor role, that T2 sympathectomy suffices for the treatment of essential palmar hyperhidrosis, and that sympathectomy for Raynaud's disease might skip stellectomy.
Wong
C W
CW
Division of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, ROC. c1951@ms12.hinet.net
D000293:Adolescent; D000328:Adult; D004564:Electrocoagulation; D005260:Female; D005728:Ganglia, Sympathetic / Q000503:physiopathology* / Q000601:surgery; D015171:Ganglionectomy; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D012881:Skin Temperature; D013900:Thoracic Nerves / Q000503:physiopathology* / Q000601:surgery